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Medicare Monday: What is CMMI?

This week Medicare Monday is looking at the Center for Medicare and Medicaid Innovation (CMMI) and why it matters to patients.

The Center for Medicare and Medicaid Innovation (CMMI) is a government body established by the Affordable Care Act (ACA) to test new models for paying for and delivering health care. The ACA gives CMMI significant flexibility to test and evaluate a wide range of these “alternative payment models” (APMs) – such as accountable care organizations, bundled payments and patient centered medical homes – both in Medicare and in the private sector. If an evaluation finds the APM reduces Medicare spending while preserving or enhancing quality of care, CMMI has the authority to expand the model, including nationwide implementation in the Medicare program. The work CMMI is doing now will shape how Medicare pays for health care in the future as it seeks to shift reimbursement to “value-based” models.

A recent letter sent to the Department of Health and Human Services (HHS) by over 70 patients and patient organizations underscored the importance of CMMI’s work. “The pivotal shift to value-based payment holds significant implications for the patient-centeredness movement and the related issues of patient access and the physician-patient relationship. Patients’ voices need to be a part of this discussion,” the letter said.

Many of the approaches being tested by CMMI hold promise for improving care coordination and quality and helping control overall health care costs. At the same time, changing the way Medicare pays for health care and incentivizes health care providers also has risks. Experts, including the RAND Corporation and Medicare Payment Advisory Commission, have noted some of the payment models under development by CMMI risk creating patient access barriers if they are not carefully designed and monitored. Because CMMI has a great deal of flexibility in conducting its work, CMMI initiatives could also result in APMs that do not incorporate many of the patient protections advocates have sought to implement in federal health care programs.

How CMMI works is unique. It is not required to follow a formal rulemaking process with opportunities for public comment. For this reason, it is important for stakeholders to be proactive in providing input into the design of CMMI models. To ensure CMMI models meet the goals of containing health care costs, better coordinating care and maintaining or improving care quality while simultaneously protecting patient access to care, it is worth considering the following:

Are APMs developed through a transparent process involving input from a wide range of stakeholders?

Do they incorporate quality measures that are meaningful to patients and give providers strong incentives to perform well on those measures?

Do they maintain Medicare’s fundamental patient protections?

Are they designed to support patient-centered care and access to beneficial treatment options?

Recent events have significantly elevated the importance of CMMI’s work. Earlier this year, Medicare set a goal of moving 50 percent of payments into APMs by 2018. On the heels of that announcement, Congress passed a law that will change how Medicare pays physicians by encouraging them to adopt APMs. The majority of these models are expected to come out of CMMI, underscoring the importance of a more transparent process for model development and evaluation.

We’ll continue to explore these important issues over the coming weeks and months. So remember to check back with us here at Medicare Monday next week.